Unmasking Juvenile Systemic Lupus Erythematosus (JSLE): Multisystemic Manifestations in an Adolescent Male, A Rare Case Report.

Juvenile Systemic Lupus Erythematosus (JSLE) is a rare and chronic multisystem autoimmune condition with an accelerated course compared with adult-onset SLE. Its heterogeneity of presentation and overlap with infectious and inflammatory conditions frequently hinders diagnosis, especially in areas where tuberculosis is endemic. A 15-year-old male patient came to the Emergency Department with his sixth attack of generalized tonic-clonic seizures within 20 days. He had a history of 8 months with complaints of joint pain, intermittent fever, rash, alopecia, and lymphadenopathy of the cervical and inguinal region. Proteinuria and abnormal liver function tests were found in laboratory investigations. Neuroimaging was found to be hyperintense lesions in the right parieto-temporal area. The autoimmune profile was found to have positive ANA, anti-Sm, and anti-RNP antibodies with decreased complement C4. Diagnosis of Juvenile Systemic Lupus Erythematosus (JSLE) along with lupus cerebritis was established. He was treated with corticosteroids, immunosuppressants, and antiepileptics. This case highlights the diagnostic difficulty of JSLE in children who come with atypical or isolated neuropsychiatric symptoms. A false interpretation of a positive IGRA resulted in a provisional diagnosis of tuberculosis, thus delaying proper treatment. Autoimmune causes such as JSLE should be considered by clinicians in children with unexplained neurological manifestations and persistent multisystemic symptoms, particularly in areas where TB burden is high.